N.H. Admin. Code § He-P 810.16

Current through Register No. 45, November 7, 2024

Section He-P 810.16 - Client Services

(a) At the time of admission, personnel of the birthing center shall:

(1) Provide, both verbally and in writing, to the client or the client's legal representative, the birthing center's policy on client rights and responsibilities, complaint procedure, and rules and obtain written confirmation acknowledging receipt of the policies;

(2) Collect and record the following information:

a. Client's name, home address, and home telephone number;

b. Client's date of birth;

c. Name, address, and telephone number of an emergency contact;

d. Name of client's primary care provider with the address and telephone number; and

e. Client's insurance information, if applicable;

(3) Provide an orientation to the scope of services provided at the birthing center;

(4) Provide instruction and education relevant to the following:

a. Conception;

b. Health and nutrition;

c. Pregnancy;

d. Lactation and lactation assistance;

e. Family planning

f. The postpartum period;

g. Holistic care;

h. Early recognition and prevention of potential health problems;

i. Detection of any abnormal conditions in the mother, fetus, and newborn;

j. Procurement of medical assistance, if necessary; and

k. Execution of emergency measures in the absence of medical help, if necessary;

(5) Complete a health examination and a social, family, medical, reproductive, nutritional, and behavioral history;

(6) Obtain from the client documentation of informed consent; and

(7) Obtain from the client a written consent for release of information, if the client so authorizes.

(b) Only clients who meet the eligibility criteria and have registered at least 4 weeks prior to the anticipated date of birth shall be admitted to the birthing center.

(c) In order to be eligible:

(1) The client's licensed or certified practitioner shall determine that the client was medically, psychologically, surgically, and obstetrically uncomplicated during her prenatal care;

(2) A client shall not present any of the following contraindications:

a. Placenta previa;

b. Multiple fetuses;

c. Insulin dependent diabetes;

d. Previous cesarean section, unless authorized in accordance with Mid 503; or

e. Rh factor sensitivity with positive antibody titre;

(3) A client shall have written approval from a medical doctor (MD), doctor of osteopathic medicine (DO) with certification in natural childbirth, or APRN-CNM to deliver in the birthing center if she presents with any of the following potential medical risk factors:

a. Maintenance on anti-epileptic medications without convulsive activity within the last year;

b. Blood dyscrasias;

c. Current hepatitis;

d. A positive HIV test result or AIDS;

e. Current alcoholism;

f. Current drug addiction, including use of hallucinogens;

g. Chronic pulmonary disease that interferes with oxygen saturation;

h. Chronic hypertension;

i. Past history of significant heart disease; or

j. Maintenance on psychotropic medication which, as a result of a consultation with the client's physician, has been determined to have a sedating effect on the newborn.

(d) All clients who present with, or develop during prenatal care, any one or more of the following shall be evaluated by a physician or a certified nurse midwife to determine appropriateness for delivery in a birthing center:

(1) Younger than 16 or older than 45 years of age;

(2) High blood pressure, which is defined as 140/90 or elevation of 30 systolic or 15 diastolic on at least 2 occasions, at least 6 hours apart;

(3) Anemia, which is defined as hemoglobin of less than 10 grams, unresolved at term;

(4) History of genetic problems or previous intrauterine death at greater than 20 weeks or unexplained stillbirth;

(5) Possibility of multiple fetuses, malpresentation, or fetus too small or large for gestational age;

(6) Past history of significant hemorrhaging during delivery, which is defined as the loss of 500 cubic centimeters (cc) of blood or greater;

(7) Abnormal Pap smear;

(8) Active primary herpes at term;

(9) Positive cervical herpes cultures;

(10) Indications that the fetus has died in utero;

(11) Suspected postmaturity greater than 42 weeks;

(12) Heart murmur or arrhythmia other than functional;

(13) Prior obstetrical problems, including, but not limited to:

a. Past prematurity;

b. Uterine abnormalities;

c. Placental abruption; and

d. Incompetent cervix;

(14) Development of other conditions potentially detrimental to the pregnancy, such as recurrent urinary tract or kidney infection or active gonorrhea;

(15) Polyhydramnios or oligohydramnios;

(16) Suspected intrauterine growth retardation;

(17) Condyloma acuminata, significant or intravaginal;

(18) Suspected premature labor less than 37 weeks;

(19) Present with or develop a significant overweight or underweight state; or

(20) Non-insulin dependent gestational diabetes or abnormal glucose challenge test.

(e) If the client's risk factors, as outlined in (d) above, have been evaluated by an MD, DO with certification in natural childbirth, or APRN-CNM and deemed appropriate for delivery in the birthing center, the MD, DO with certification in natural childbirth, or APRN-CNM shall:

(1) Provide written documentation of their approval; and

(2) Include this documentation as part of the client's record.

(f) Any client who develops the following conditions during prenatal care shall be prohibited from delivery at the birthing center and transferred to the care of a physician or a certified nurse midwife for a hospital delivery:

(1) Multiple fetuses;

(2) Malpresentation, including breech position, that is not resolved before the onset of labor;

(3) Confirmation that the fetus is small for gestational age;

(4) Placenta previa or abruptio placenta;

(5) Onset of labor prior to the 37th week of pregnancy; or

(6) Insulin dependent diabetes.

(g) A care plan shall be developed and revised based on needs identified by the client's licensed or certified practitioner.

(h) If a certified midwife is the primary practitioner, the midwife shall consult with a physician or licensed APRN who is certified as a midwife and develop a plan of care for all clients who present with the following conditions:

(1) Maternal distress as indicated by:

a. Hypertension; which is a systolic reading of 30 mm of mercury and a diastolic reading of 15 mm of mercury over baseline;

b. Blood loss greater than 500 cc; or

c. Temperature greater than 100 degrees Fahrenheit or less than 97 degrees Fahrenheit;

(2) Prolonged rupture of the membranes prior to the onset of labor for more than 18 hours;

(3) Fetal distress as indicated by:

a. Persistent bradycardia;

b. Persistent tachycardia; or

c. Particulate meconium;

(4) Failure to progress in spite of active labor that is defined as:

a. A lack of steady dilation and descent after 24 hours for primigravida or 18 hours for multigravida during the first stage of labor;

b. A lack of fetal descent after 2 hours during the second stage of labor; or

c. Failure to deliver the placenta after one hour during the third stage of labor;

(5) Neonatal distress as indicated by:

a. Obvious congenital anomalies;

b. Apical pulse rate greater than 160 per minute;

c. Respiratory rate greater than 80 per minute;

d. Temperature outside the parameters of 97.7 to 99.4 degrees Fahrenheit or 36.5 to 37.5 degrees Celsius;

e. Persistent signs of respiratory difficulty without signs of improvement within one hour after birth;

f. Persistent central cyanosis or pallor;

g. Signs of hypoglycemia, such as jitteriness, lethargy or hypothermia;

h. Jaundice appearing before 24 hours after birth;

i. Small for gestational age; or

j. A 5 minute Apgar score that is 6 or 7.

(i) All clients who present the following conditions during labor or delivery shall be immediately transferred to a hospital:

(1) Malpresentation;

(2) Multiple fetuses;

(3) Prolapsed cord;

(4) Neonatal distress as indicated by:

a. Apnea with persistent central cyanosis or pallor;

b. Persistent grunting and retractions;

c. A 5 minute Apgar score of 5 or less, or failure to achieve an Apgar score of 7 within 30 minutes; or

d. Jaundice before 24 hours; or

(5) Uncontrolled maternal bleeding.

(j) Prenatal care shall be provided at the home of the client, at the office of the licensed practitioner, or at the birthing center.

(k) Prenatal care shall include, but is not limited to:

(1) A health examination including pelvic and speculum exam, as applicable;

(2) A social, family, medical, reproductive, nutritional, and behavioral history;

(3) Assessing vital signs including blood pressure;

(4) Arranging for the following blood tests if not previously completed during the present pregnancy:

a. Complete blood count (CBC);

b. Blood type and Rh antibody screen;

c. Rubella titre;

d. Syphilis serology;

e. Hepatitis B surface antigen; and

f. HIV testing, if requested by the client;

(5) An initial nutritional assessment and counseling;

(6) Pap smear, if not done in the last 2 years;

(7) Chlamydia and gonorrhea screening tests, as applicable;

(8) Establishment of gestational age; and

(9) Advising of available prenatal testing.

(l) Following the initial visit, the licensed or certified practitioner shall see the client:

(1) Once a month through the 28th week of pregnancy;

(2) Once every 2 weeks from the 28th week until the 36th week of pregnancy; and

(3) Once a week from the 36th week of pregnancy until the onset of labor.

(m) Each prenatal visit shall include, but is not limited to, the following care:

(1) Determining weight;

(2) Assessing blood pressure;

(3) Urine dip for protein and glucose, which may be performed by the client;

(4) Assessment of general health;

(5) Monitoring of uterine measurements, fetal heart rate, and fetal activity; and

(6) Arranging for birthing center tests or procedures as indicated.

(n) Intrapartum care shall include, but is not limited to:

(1) Monitoring the condition of mother and fetus;

(2) Providing emotional and physical support;

(3) Assisting with the delivery;

(4) Repairing minor tears or episiotomies as necessary;

(5) Examination and assessment of the newborn;

(6) Inspection of the placenta, membranes, and cord vessels; and

(7) Management of any maternal or neonatal complications.

(o) Postpartum care shall include, but is not limited to:

(1) Remaining with the client and newborn for a minimum of 2 hours after birth or until:

a. The infant:

1. Is alert;

2. Has good color;

3. Has a good sucking reflex;

4. Is breathing normally; and

5. Has a stable temperature within the range of 97 to 100 degrees F; and

b. The mother:

1. Has a firm fundus;

2. Does not have excessive vaginal bleeding;

3. Is afebrile;

4. Has voided; and

5. Has established successful breastfeeding, if applicable;

(2) Obtaining or arranging for a blood sample from the newborn for metabolic disorders as required by RSA 132:10-a;

(3) Providing the client with information on routine postpartum and newborn care, including follow up care with a pediatrician or family practitioner for the newborn;

(4) Providing the client's obstetrician, primary care physician, pediatrician, or certified nurse midwife with a written summary of labor and delivery and an assessment of the newborn;

(5) Contacting the client by telephone within 24 hours of discharge to establish well-being and health of mother and newborn;

(6) Providing 2 postpartum visits within 6 weeks of delivery; and

(7) Managing any complications that may arise and, based on the complication:

a. Consulting with a physician under the arrangements required by Mid 502.06 or a certified nurse midwife; or

b. Transferring the client with notification to the consulting physician or certified nurse midwife.

(p) The certified nurse midwife or certified midwife, or other person authorized by law, shall administer the following medications as clinically indicated:

(1) Rhogam (immune globulin) for Rh blood incompatibility;

(2) Eye prophylaxis for prevention of gonococcal infection in the newborn;

(3) Oxygen for fetal distress and infant resuscitation;

(4) Lidocaine hydrochloride by infiltration only for the purpose of postpartum repair of tears, lacerations, or episiotomies;

(5) Vitamin K, orally or intramuscular, for prevention of hemorrhagic disease in the newborn;

(6) Oxytocins, orally or intramuscular, for control of postpartum maternal hemorrhage; and

(7) Intravenous fluids as an emergency measure for maternal complications.

(q) Birthing center personnel shall follow the orders of the licensed or certified practitioner.

(r) The client's record shall contain written notes for:

(1) All care and services provided at the birthing center, including:

a. Date and time that the care or services were provided;

b. Description of the care or services provided;

c. Client's response to the care or services provided; and

d. Signature and title of the person providing the care or service; and

(2) Any reportable incidents involving the client, which shall include, but not be limited to:

a. Date and time of the reportable incident;

b. Description of the reportable incident, including identification of injuries, if applicable;

c. Actions taken by personnel, including follow-up;

d. Date and time the emergency contact person, guardian, or agent acting pursuant to a DPOA and the licensed or certified practitioner were notified if medical intervention was required;

e. Signature and title of the person reporting the unusual incident; and

f. Signature and title of the person completing the report.

(s) The use of chemical or physical restraints shall be prohibited except as allowed by RSA 151:21, IX.

(t) In addition to (s) above, the use of mechanical restraints shall be prohibited.

(u) Clients shall be transferred or discharged from the birthing center:

(1) In accordance with:

a.RSA 151:21,V and RSA 151:26; and

b. The birthing center's policies; and

(2) When there is:

a. A written order from a licensed practitioner;

b. A medical emergency and the client is in need of care and services not available at the birthing center; or

c. The client has developed one of the conditions listed in (f) above.

(v) A summary shall be written for any client discharged or transferred from the birthing center which includes:

(1) The date and time the client left the birthing center;

(2) The place to which the client was transferred or discharged;

(3) The condition of the client at the time of discharge or transfer; and

(4) The discharge plan and instructions for home and follow up care.

(w) After receiving permission from the client or legal representative, copies of the clinical progress notes and medication records shall accompany the transferred client.

(x) For each client accepted for care and services at the birthing center, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by (a) (1) above;

(2) The identification data required by (a) (2) above;

(3) The record of the health examination required by (a) (5) above;

(4) Consent forms and release forms required by (a) (7) above;

(5) All orders from a licensed practitioner, including the date and signature of the licensed practitioner;

(6) Results of any birthing center tests or ultrasounds;

(7) All consultation reports;

(8) All assessments;

(9) All written notes required by (r) above; and

(10) A discharge or transfer summary as required by (v) above.

(y) Client records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when being used by the birthing center's personnel.

(z) Client records shall be retained for a minimum of 4 years after discharge or, in the case of a minor, until one year after reaching age 18, but no less than 4 years after discharge.

(aa) Prior to the birthing center ceasing operation, it shall arrange for the storage of and access to client records for 4 years after the date of closure, which shall be made available to the department and past clients upon request.

N.H. Admin. Code § He-P 810.16

#8957, eff 7-27-07

Amended by Volume XXXVI Number 36, Filed September 8, 2016, Proposed by #11161, Effective 8/20/2016, Expires 8/20/2026.